Individual
KIMBERLY D PETERSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
B.S. OTR/L
Contact information
Practice address
3022 CHISHOLM CT, WAXHAW, NC 28173-7865
(704) 843-2020
(704) 843-8384
Mailing address
4100 EXBURY GARDENS DR, WAXHAW, NC 28173-6961
(704) 256-4270
Taxonomy
Speciality
Code
Description
License number
State
225XP0200X
Pediatric Occupational Therapist
Primary
6775
NC
Other
Enumeration date
02/19/2008
Last updated
02/19/2008
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